Session 19: Medical Waste Management
John Azu, GEMS November 2012
GEMS Environmental Compliance-ESDM Training Series Africa-Asia-Latin America-Middle East 2012-2013
What is Medical Waste?
2
The term includes what is commonly described as garbage, refuse and trash. The US EPA’s regulatory definition of waste includes any discarded item; things destined for reuse, recycle, or reclamation; sludge and hazardous waste. It is also called healthcare waste or clinical waste.
Broadly, medical waste is defined as any solid or liquid waste generated in the diagnosis, treatment or immunization of human beings or animals in research pertaining thereto, or in the production or testing of biological (NAN & HCWH, 1999 Medical Waste in Developing Countries).
3
Sources of Medical Waste
Different sections of
hospitals and clinics
Pathological laboratories
Diagnostic centers Doctors’ offices
Other medical and research
facilities
Food facilities Medical stores
4
Classification of Medical Waste
A. Based on content (solid, liquid, gaseous, radioactive) B. Based on health impact (general waste and hazardous waste)
C. Based on WHO classification for developing countries (general waste, sharp waste, infectious waste, chemicals and pharmaceutical waste, other hazardous waste).
Anatomical Pathological
Chemical Pharmaceutical
Non-infectious Infectious Sharps
Hazardous Non- hazardous
Radio Gaseous Solid Liquid
Classification of Solid Medical Waste
5
Waste Components Generated by Healthcare Activities
These wastes include hazardous (sharps, infectious and non-infectious) and non-hazardous materials (general waste):
Sharps (used needles,
syringes, blades, scalpel, razors, broken
glass) Soiled dressings
Pathological materials (human tissue, organ
feces, body parts, biopsy products and autopsy materials)
Diagnostic samples
Blood
Chemicals (reagents, developers, and those
toxic, flammable, explosive and or
carcinogenic)
Pharmaceuticals (expired medication, discarded residual medication used in
chemotherapy)
Medical devices
Radioactive materials (solid or liquid waste contaminated with
radioactive substances)
Normal kitchen and office waste (similar to municipal solid waste)
6
Composition of Medical Waste Nature and Composition of Medical Waste
General waste, 80%
Sharps, 1%
Chemical, 3%
Infectious, 15%
Others, 1%
Source: WHO, 2000
7
Category of Waste, Examples and Environmental Concerns
Category Examples Environmental concerns General or Municipal Solid waste Paper, packaging, food, floor sweepings and other items not
unique to medical waste, commonly managed by municipal collection and disposal
Volume of the waste; Air emissions; Contamination of surface and ground water; Litter; Insects or other vectors; Odors; Injury; Exposure to Pathogens
Infectious waste containing pathogens in sufficient quantity that exposure could result in disease
Lab cultures and stocks of infectious agents, wastes from isolation wards, tissues, materials or equipment that have been in contact with infected patients
Land disposal of active pathogens Human health impacts
Pharmaceutical waste Expired or unnecessary pharmaceuticals and drugs Released to land or water Human health impacts
Pathological waste containing human tissues or
Body parts, human fetuses, blood, and other body fluids. Untreated waste released to land or water; Human health impacts
Chemical waste Solid, liquid and gaseous chemicals from diagnostic and experimental work, cleaning materials
Released of hazardous air pollutants and releases to land or water; Human health impacts
Sharp wastes Needles, infusion sets, scalpels, broken glass Land disposal of active pathogens; Injury
Radioactive waste Radioactive substances including used liquids from radiotherapy or lab work
Releases to air, land or water; Human health impacts
Pressurized containers Gas cylinders, cartridges and aerosol cans Potentially harmful; May explode accidentally
High heavy metal content Batteries, broken thermometers, blood pressure gauges Releases to air, land or water; Human health impacts
Genotoxic waste Waste containing cytotoxic drugs (used in cancer therapy), genotoxic chemicals
Releases to air, land or water; Human health impacts
Source: Medical waste training manual, DGHS, Mohakhali, Dhaka
8
The Disease Transmission Cycle
Infectious Agent Bacteria Viruses Fungi
Parasites
Reservoir People
Water bodies Instruments Equipment
Places of Exit Skin,
Respiratory, system Genitourinary
& vascular systems
Mode of Transmission
Contact Vehicle
Air Vector
Places of entry Broken skin
Puncture wound surgical site
Mucous membranes
Susceptible Hosts Clients
Community Service providers
Ancillary staff Com. members
Source: Medical waste training manual, DGHS, Mohakhali, Dhaka
9
Potential Risks and Hazards Associated with Medical Waste
2. Infectious medical waste and the Associated Risks
Pathogenic Organisms in Infections Waste Associated Diseases
Bacterial Tetanus, gas gangrene and other wound infection, anthrax, cholera, other diarrhoeal diseases, enteric fever, shigellosis, plague etc.
Viral Various hepatitis, poliomyelitis, HIV-infections, HBV, TB, STD rabies etc.
Parasitic Amoebiasis, giardiasis, ascariasis, ankylomastomiasis, taeniasis, echinococcosis, malaria, leishmaniasis, filariasis etc.
Fungal infections Various fungal infections like candidiasis, cryptococcoses, coccidiodomycosis etc.
Source: WHO, 2000.
1. Injuries and accidents (Nurses and housekeeping personnel are the main groups at risk associated with cut-injury, punctured wound, laceration, strain and sprain of the joint of limbs and backache).
3. Hazardous medical waste risk (due to types of chemicals used in medical facilities and pharmaceutical industries)
4. Groups at most risk (Waste pickers, Waste recyclers, Drug addicts (who scavenge for used needles and disposed medicines) and hospital sweepers and other low-grade hospital staff).
10
Medical Waste Management
Medical waste management is the practice of minimizing, identifying, separating, collecting, handling,
carrying, storing and treating and finally disposing of medical waste as
per policy of the institution or government.
Definition
11
• Minimize occupational health hazards and
• Develop environmentally
friendly medical facility.
Careful management is required to:
!
In-House Medical Waste Management
Elements of In-House Waste Management
WASTE MINIMIZATION
WASTE IDENTIFICATION
WASTE SEGREGATION
WASTE HANDLING WASTE TREATMENT & DISPOSAL
RECORD KEEPING
TRAINING
SUPERVISION & MONITORING
Waste Management Cycle (WHO)
12
13
• Source reduction
• Stock management
• Encourage use of Recyclable products
• Control at institution level
• Centralized purchase and monitoring the receipt and supply procedure of medical goods.
1. Waste Minimization
a. Important Elements for effective in-house waste management
14
• Waste separation/isolation is a key to effective waste management
• The waste is segregated on the basis of composition/type of waste
• Segregation of waste should occur at the point just after its generation
• Effective segregation ensures that only small quantities rather than large ones are needed for disposal
• Incorrect segregation leads to contamination of a large volume of non-hazardous waste turning the whole pack into hazardous waste
2. Waste Segregation:
b. Important Elements for effective in-house waste management
15
c. Important Elements for effective in-house waste management
A good way of identifying the waste is by sorting the different components of waste into different COLOR CODE to facilitate easy and safe handling, transportation and waste treatment.
3. Waste Identification:
Recommended Color Code for Developing Countries (WHO)
Type of waste Color code Highly infectious Red Infectious, Pathological, Anatomical Yellow Sharp Yellow colored box Chemicals, Pharmaceuticals Brown Radioactive Silver General waste Black
16
d. Important Elements for effective in-house waste management
• Waste collection (regular and programmed)
• Waste collection materials (gloves, apron, boots, trolley)
• Placement of color bins (where the waste is generated)
• Labeling (containers must be labeled with some basic information)
• Security (required to prevent scavenging at the generation and disposal sites)
• Health and safety of the cleaner in waste management • Personal hygiene (continuous water supply and soap/detergent for
hand-washing)
• Response to injury and exposure (need for procedures to deal with accidents)
• Emergency response (trained personnel and necessary equipment)
4. Waste Segregation:
17
• Moving from site of collection to temporary storage area in-house
• There must be equipment for transporting waste containers
• The equipment must be easy to clean, load and unload, leak proof
Should not be used for any work other than waste transportation
5. In-house transportation
e. Important Elements for effective in-house waste management
18
f. Important Elements for effective in-house waste management
• The store should be a room, area or building within the healthcare facility- depending on the quantity of waste generated
• Waste must not be stored for more than 24 hours
• Should not be accessible to unauthorized persons and animals
• Must be located away from food preparation, processing and food store
• Should provide easy access to collectors and collection vehicles
• Storage room must be properly ventilated
6. Temporary in-house storage • Accurate record keeping is
required for effective medical waste management
• Various records related to risks, failures and problems, cost, quality and quantity of waste etc., must be taken
7. Record keeping
19
Transportation for Out-House Management
Collection of stored waste (except
radioactive waste) from healthcare facilities
according to color code to the final disposal site
is done in a covered truck.
Collection of waste as per color-coded from different institutions should be in a
covered van and the driver area should be
totally separated from the waste carrying area
Out-House Management and Final Disposal of Medical Waste
Outside hospital (Total system)
Same car different time
Disposal site Protected Landfill
Treatment
Central incineration
Municipality
Private firms/NGOs
Big Hosp. Public/private
Management
Collection
Transport
Gen. Waste
Infect. Waste
Ash
Institutional Cooperation
Optimum & proper resource utilization
Public Participation
Public-Private Partnership
20
21
Technologies for Treatment and Final Disposal
• (High temperature dry oxidation process to reduce organic and combustible waste to inorganic matter) Incineration
• (Chemicals added to waste to kill/inactivate the pathogens) Chemical disinfection • (Mixing waste with cement in order to prevent
leaching/migration of toxic substances) Rendering inert
• -including autoclaving (Exposure of shredded waste to high temperature and pressure to inactivate micro-organisms before discharge into municipal waste)
Wet thermal treatment
• (The heat generated destroys microorganisms) Microwave irradiation
• (Isolates waste from the environment) Landfill (Sanitary)
• (pre-treatment involving filling containers with waste, adding an immobilizing material and sealing the container) Encapsulation
External Waste Management and Final disposal of MWM
22
Improper MWMS
Inadequate Disposal Site
Unauthorized Waste Picking
Inadequate Treatment
Inadequate Collection system
Non-existence of Regulations
Resource Constraint
Lack of Awareness
Absence of Responsibility
Solid Waste Management
Outside Hospital (Total system)
In-house Management
Public and Political Awareness
Disposal
Collection
Treatment
Transport Training Good house keeping
Capacity building
Health & environment
Civic sense
Step by Step Implement
Requirements for Effective Waste Management
23
National Policy,
Strategy, plan,
guidelines and SOPs
Legislation /Rules for
waste management
Good management
Committed manpower
Good management
Proper budgetary allocation
Application of local available
technology and also
according to resource allocation
Involvement of NGOs
Community participation
Proper capacity
development of the service
providers
Development of information
system in relation to MWM as a part of MIS
Supportive supervision
and monitoring
24